Forearm Skin Blood Flow Research Articles

Obesity-induced impairment of endothelium-dependent vasodilation in Tunisian women

It is now well recognized that obesity is a major public health concern, and its prevalence has tremendously increased worldwide over the last decades, including Tunisia. As obesity is associated with cardiovascular diseases, the purpose of this study was to investigate the effect of obesity on forearm skin blood flow (FSBF) response to acetylcholine (Ach), an endothelium-dependent vasodilator, in Tunisian women over a wide range of body mass indices (BMIs). One hundred and eighty healthy women with an average age of 34+/-6 years, an average height of 162+/-7 cm and an average weight of 78+/-19 kg participated in this investigation. The mean BMIs of the 60 lean, 50 overweight and 70 obese subjects were 22.1+/-0.3, 27.7+/-0.2 and 38.4+/-0.7 kg m(-2), respectively. The FSBF was measured non-invasively using a laser Doppler flowmeter in response to local infusion of a cumulative dose of Ach. After adjusting for age, the mean response of FSBF to Ach was significantly greater in lean (1168%+/-78) than in overweight (643%+/-38) and obese subjects (323%+/-18) (P=0.002; P<0.0001, respectively), suggesting a reduction of the endothelium-dependent nitric oxide (NO) release by obesity. Our regression analysis also revealed that the maximum FSBF response to Ach (that is, its efficacy) was inversely correlated with BMI, waist and hip circumferences (r=-0.994, P=0.002; r=-0.2, P<0.0001, and r=-0.321, P=0.001, respectively). Our data demonstrate a reduction of skin vasodilatory reserve in obese patients and suggest a defect of both endothelial-dependent relaxation and wall compliance associated with obesity.

Haemodialysis acutely reduces the plasma levels of ADMA without reversing impaired NO-dependent vasodilation

End-stage renal disease patients have endothelial dysfunction and high plasma levels of ADMA (asymmetric omega-NG,NG-dimethylarginine), an endogenous inhibitor of NOS (NO synthase). The actual link between these abnormalities is controversial. Therefore, in the present study, we investigated whether HD (haemodialysis) has an acute impact on NO-dependent vasodilation and plasma ADMA in these patients. A total of 24 patients undergoing maintenance HD (HD group) and 24 age- and gender-matched healthy controls (Control group) were enrolled. The increase in forearm SkBF (skin blood flow) caused by local heating to 41 degrees C (SkBF41), known to depend on endothelial NO production, was determined with laser Doppler imaging. SkBF41 was expressed as a percentage of the vasodilatory reserve obtained from the maximal SkBF induced by local heating to 43 degrees C (independent of NO). In HD patients, SkBF41 was assessed on two successive HD sessions, once immediately before and once immediately after HD. Plasma ADMA was assayed simultaneously with MS/MS (tandem MS). In the Control group, SkBF41 was determined twice, on two different days, and plasma ADMA was assayed once. In HD patients, SkBF41 was identical before (82.2+/-13.1%) and after (82.7+/-12.4%) HD, but was lower than in controls (day 1, 89.6+/-6.1; day 2, 89.2+/-6.9%; P<0.01 compared with the HD group). In contrast, plasma ADMA was higher before (0.98+/-0.17 micromol/l) than after (0.58+/-0.10 micromol/l; P<0.01) HD. ADMA levels after HD did not differ from those obtained in controls (0.56+/-0.11 micromol/l). These findings show that HD patients have impaired NO-dependent vasodilation in forearm skin, an abnormality not acutely reversed by HD and not explained by ADMA accumulation.

Detrended fluctuation analysis of laser Doppler flowmetry time series

Detrended fluctuation analysis (DFA) of laser Doppler flow (LDF) time series appears to yield improved prognostic power in microvascular dysfunction, through calculation of the scaling exponent, α. In the present study the long lasting strenuous activity-induced change in microvascular function was evaluated by DFA in basketball players compared with sedentary control. Forearm skin blood flow was measured at rest and during local heating. Three scaling exponents, the slopes of the three regression lines, were identified corresponding to cardiac, cardio-respiratory and local factors. Local scaling exponent was always approximately one, α = 1.01 ± 0.15, in the control group and did not change with local heating. However, we found a broken line with two scaling exponents ( α 1 = 1.06 ± 0.01 and α 2 = 0.75 ± 0.01) in basketball players. The broken line became a single line having one scaling exponent ( α T = 0.94 ± 0.01) with local heating. The scaling exponents, α 2 and α T, smaller than 1 indicate reduced long-range correlation in blood flow due to a loss of integration in local mechanisms and suggest endothelial dysfunction as the most likely candidate. Evaluation of microvascular function from a baseline LDF signal at rest is the superiority of DFA to other methods, spectral or not, that use the amplitude changes of evoked relative signal.

Neural and non‐neural control of skin blood flow during isometric handgrip exercise in the heat stressed human

During heat stress, isometric handgrip (IHG) exercise causes cutaneous vasoconstriction, but it remains controversial whether neural mechanisms are responsible for this observation. The objective of this study was to test the hypothesis that cutaneous vasoconstriction during IHG exercise in heat stressed individuals occurs via a neural mechanism. An axillary nerve blockade was performed to block efferent nerve traffic to the left forearm in seven healthy subjects. Two intradermal microdialysis probes were placed within forearm skin of the blocked area. Forearm skin blood flow was measured by laser-Doppler flowmetry over the microdialysis probes as well as from skin of the contralateral (unblocked) forearm. Cutaneous vascular conductance (CVC) was calculated from the ratio of skin blood flow to mean arterial pressure. Effectiveness of nerve blockade was verified by the absence of tactile sensation, as well as an absence of sweating and cutaneous vasodilatation during a whole-body heat stress. Upon this confirmation, adenosine was perfused through one of the microdialysis probes to increase skin blood flow similar to that of the unblocked site. After internal temperature increased approximately 0.7 degrees C, subjects performed 2 min of IHG exercise at 35% of maximal voluntary contraction using the non-blocked arm. IHG exercise significantly decreased CVC at the unblocked site (82.3 +/- 5.7 to 70.9 +/- 5.4%max, P = 0.005, means +/- S.E.M.) and the adenosine treated site of the blocked arm (75.2 +/- 7.2 to 68.3 +/- 6.6%max, P = 0.005), whereas CVC was unchanged at the blocked site that did not receive adenosine (15.7 +/- 2.8 to 13.7 +/- 2.0%max, P = 0.10). Importantly, the reduction in CVC was greater at the unblocked site than at the adenosine treated site (11.4 +/- 2.6 vs. 6.9 +/- 1.6%max, respectively, P = 0.01). These findings suggest that neural and non-neural mechanisms contribute to the reduction in forearm CVC during IHG exercise in heat stressed humans.

Caffeine during Exercise in the Heat

To investigate the effects of caffeine ingestion on thermoregulation and fluid-electrolyte losses during prolonged exercise in the heat. Seven endurance-trained ( .VO2max = 61 +/- 8 mL.kg.min) heat-acclimated cyclists pedaled for 120 min at 63% .VO2max in a hot-dry environment (36 degrees C; 29% humidity) on six occasions: 1) without rehydration (NF); 2) rehydrating 97% of sweat losses with water (WAT); 3) rehydrating the same volume with a 6% carbohydrate-electrolytes solution (CES); or combining these treatments with the ingestion of 6 mg caffeine.kg (-1) body weight 45 min before exercise, that is, 4) C(AFF) + NF; 5) C(AFF) + WAT; and 6) C(AFF) + CES. Without fluid replacement (NF and C(AFF) + NF), final rectal temperature (T(REC)) reached 39.4 +/- 0.1 degrees C, whereas it remained at 38.7 +/- 0.1 degrees C during WAT (CES and C(AFF)+ WAT; (P < 0.05). Caffeine did not alter heat production, forearm skin blood flow, or sweat rate. However, C(AFF) + CES tended to elevate T(REC) above CES alone (38.9 +/- 0.1 degrees C vs 38.6 +/- 0.1 degrees C; P = 0.07). Caffeine ingestion increased sweat losses of sodium, chloride, and potassium ( approximately 14%; P < 0.05) and enlarged urine flow (28%; P < 0.05). Caffeine ingested alone or in combination with water or a sports drink was not thermogenic or impaired heat dissipation. However, C(AFF) + CES tended to have a higher T(REC) than CES alone. Caffeine increased urine flow and sweat electrolyte excretion, but these effects are not enough to affect dehydration or blood electrolyte levels when exercising for 120 min in a hot environment.

水循環スーツを着用した運動時の体温調節反応と冷却面積，冷却容量との関係

This study analyzed the effects of various body surface areas being cooled by water-perfused suits (WPS) on thermoregulatory response during exercise in a hot environment. Seven male subjects, dressed in clothing with low moisture permeability (rain coats) over WPS covering the whole body surface except for the face, hands, and feet, performed three sessions of 20-min cycling at low intensity (250w/m2) in a room maintained at 30℃ under six conditions of body surface cooling : whole body (WB), upper body (UB), lower body (LB), lower body except lower legs (LBEL), head and neck (HN), and no body cooling (NBC). The coolant temperature at the inlet was 20℃ for all conditions, and heat extraction (HE) was estimated by the difference between inlet and outlet water temperatures and water flow rate. Esophageal (Tes) and deep thigh temperatures (T-d.thigh) and heart rate (HR) during exercise were significantly (p＜0.01) higher for NBC and HN, and forearm skin blood flow (SkBF) and dehydration (DEH) were significantly (p＜0.01) lower for WB than for other conditions. There was a similar tendency concerning Tes and T-d.thigh among WB, LBEL, and LB ; however, T-d.thigh for UB was significantly (p＜0.01) higher than for WB, LBEL, and LB. In comparison with resting levels, the mean skin temperature (Tsk) and thermal sensation (TS) significantly (p＜0.01) increased for NBC and HN, and decreased for UB and WB, but remained constant for LBEL and LB during exercise. Under all conditions, increases in Tes (ΔTes) and T-d.thigh (ΔT-d.thigh) at the end of exercise were significantly (p＜0.01) increased when less than 40% of the body surface was cooled (Tsk : above 35.8℃, HE : less than 110W). Furthermore, ΔTes at the end of the exercise was related to ΔTsk×SkBF, while the slope of the regression line between those parameters was steeper when ΔTsk×SkBF values were negative, as opposed to positive values. These results suggest that during light exercise under different body surface cooling conditions : 1) UB leads to a high T-d.thigh while Tes, Tsk, and TS are as low as those for WB, 2) critical levels of body surface cooling area causing a decrease in core temperature elevation might exist, and 3) changes in blood circulation due to body cooling might be affecting temperature responses at the end of exercise.

Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome?

IntroductionThe study objectives were to evaluate septic shock-induced alterations in skeletal muscle hemoglobin oxygenation saturation (StO2) using near-infrared spectroscopy (NIRS) and forearm skin blood flow velocity using laser Doppler (LD) to determine the relationship of macroperfusion and microperfusion parameters, and to test the relationship of the worst NIRS parameters during the first 24 hours of shock with 28-day prognosis.MethodsA prospective, observational study was performed in a 21-bed university hospital surgical intensive care unit. Forty-three septic shock patients with at least another organ failure underwent a 3-minute, upper arm (brachial artery) vascular occlusion test (VOT). Microperfusion parameters (thenar eminence StO2 and forearm LD skin blood flow) were collected on days 1, 2 and 3, before (baseline StO2 and LD values) and during the 3-minute VOT with calculation of occlusion and reperfusion slopes for StO2 and LD. Daily Sequential Organ Failure Assessment (SOFA) score, macrohemodynamic parameters (systolic arterial blood pressure, cardiac output (pulmonary artery catheter or transesophageal Doppler), mixed venous oxygen saturation (pulmonary artery or superior vena cava catheter)) and metabolic parameters (pH, base excess, lactate) were determined.ResultsBaseline StO2 (82% (75 to 88) vs. 89% (85 to 92), P = 0.04) and reperfusion slope (2.79%/second (1.75 to 4.32) vs. 9.35%/second (8.32 to 11.57), P < 0.0001) were lower in septic shock patients than in healthy volunteers. StO2 reperfusion slope correlated with occlusion slope (P < 0.0001), cardiac output (P = 0.01) and LD reperfusion slope (P = 0.08), and negatively with lactate level (P = 0.04). The worst StO2 reperfusion slope during the first day of shock was lower in nonsurvivors than in survivors (P = 0.003) and improved significantly the predictive value of Simplified Acute Physiology Score II and SOFA scores.ConclusionsThe alteration of StO2 reperfusion slope in septic shock patients compared with healthy volunteers was related with macrohemodynamic, microhemodynamic and metabolic parameters. The addition of the worst value of the day 1 StO2 reperfusion slope improved the outcome prediction of Simplified Acute Physiology Score II and SOFA scores.

The pattern of physical activity in relation to health outcomes in boys

Spontaneous and transitory movement patterns are characteristic of children. The aim of this study was to explore the relationship between short, frequent activity bouts and children's health. Physical activity was recorded every 2 s by accelerometry (ActiGraph GT1M) for seven days in 47 boys (age 8-10 years). Summary activity measures and activity pattern characteristics (frequency, intensity and duration of > or = 4 s [short] and > or = 5 min [long] bouts of > or= light [> or = LIGHT], > or = moderate [> or = MOD], > or = vigorous [> or = VIG], and > or = hard [> or = HARD] intensity activity) were recorded. Microvascular function was assessed using laser Doppler perfusion imaging as the forearm skin blood flow response to the iontophoretic application of acetylcholine (endothelial dependent vasodilator) and sodium nitroprusside (endothelial independent vasodilator) at rest and following maximal exercise. Waist circumference, resting blood pressure and aerobic fitness (VO(2peak)) were measured. The intensity of short and long > or = LIGHT bouts and the frequency of short and long > or =MOD bouts were correlated with waist circumference (r = - 0.42 to -0.52, p < 0.01) and VO(2peak) (r = 0.42 to 0.47, p < 0.01), but not when scaled for lean body mass. The frequency of short and long > or =LIGHT bouts were associated with change in endothelial function from rest to post-exercise (r = 0.34 to 0.55, p < 0.05). No relationships were evident between blood pressure and activity. The relationship between the frequency of short bouts (> or =4 s) of activity and health was as strong as relationships identified between longer bouts (> or =5 min) and health. This is encouraging as sporadic intermittent activity is characteristic of children's activity pattern.

Comparison of skin microvascular reactivity with hemostatic markers of endothelial dysfunction and damage in type 2 diabetes

Patients with non-insulin-dependent diabetes mellitus (NIDDM) are at increased cardiovascular risk due to an accelerated atherosclerotic process. The present study aimed to compare skin microvascular function, pulse wave velocity (PWV), and a variety of hemostatic markers of endothelium injury [von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), tissue factor pathway inhibitor (TFPI), and the soluble form of thrombomodulin (s-TM)] in patients with NIDDM. 54 patients with NIDDM and 38 sex- and age-matched controls were studied. 27 diabetics had no overt micro- and/or macrovascular complications, while the remainder had either or both. The forearm skin blood flow was assessed by laser-Doppler imaging, which allowed the measurement of the response to iontophoretically applied acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation), as well as the reactive hyperemia triggered by the transient occlusion of the circulation. Both endothelial and non-endothelial reactivity were significantly blunted in diabetics, regardless of the presence or the absence of vascular complications. Plasma vWF, TFPI and s-TM levels were significantly increased compared with controls only in patients exhibiting vascular complications. Concentrations of t-PA and PAI-1 were significantly increased in the two groups of diabetics versus controls. In NIDDM, both endothelium-dependent and -independent microvascular skin reactivity are impaired, whether or not underlying vascular complications exist. It also appears that microvascular endothelial dysfunction is not necessarily associated in NIDDM with increased circulating levels of hemostatic markers of endothelial damage known to reflect a hypercoagulable state.

Thermoregulatory Responses to Constant versus Variable-Intensity Exercise in the Heat

To compare the thermoregulatory responses between constant (CON) and variable-intensity exercise (VAR) in a dry-hot environment (36 degrees C, 29% relative humidity, and 2.5 m x s(-1) airflow). In a random order, seven endurance-trained, heat-acclimated subjects cycled either at 60% VO2max (CON) or alternating 1.5 min at 90% VO2max with 4.5 min at 50% VO2max (VAR). Total work output (915 +/- 100 kJ) and exercise duration (90 min) were identical in both trials. Net metabolic heat production was not different between trials (394 +/- 12 vs 408+/- 11 W x m(-2) for VAR vs CON). However, heat storage (60 +/- 3 vs 48 +/- 4 W x m(-2)), the increase in rectal temperature (1.6 +/- 0.1 vs 1.3 +/- 0.1 degrees C), and final heart rate (HR; 147 +/- 5 vs 141 +/- 4 beats x min(-1)) were all higher for VAR than for CON (P < 0.05). During VAR, averaged forearm skin blood flow (S(K)BF) was lower, whereas whole-body sweat rate (1.23 +/- 0.1 vs 1.11 +/- 0.1 L x h(-1)) and dehydration (2.8 +/- 0.1% vs 2.5 +/- 0.2%) were higher than during CON (P < 0.05). Final blood lactate during VAR was higher than during CON (3.5+/- 0.4 vs 2.1 +/- 0.3 mmol x L(-1); P < 0.05). Ninety minutes of variable-intensity exercise in a hot environment increases heat storage and fluid deficit in comparison to the same amount of work performed in a constant-load mode. VAR increases not only thermal (i.e., heat storage) but also cardiovascular (i.e., heart rate) and metabolic (i.e., blood lactate) stresses, which makes it less advisable than CON when the goal is to minimize physiological stress.

Low-frequency blood flow oscillations in congestive heart failure and after β1-blockade treatment

Laser Doppler flowmetry (LDF) of forearm skin blood flow, combined with iontophoretically-administered acetylcholine and sodium nitroprusside and wavelet spectral analysis, was used for noninvasive evaluation of endothelial function in 17 patients newly diagnosed with New York Heart Association class II–III congestive heart failure (CHF). After 20±10 weeks' treatment with a β1-blocker (Bisoprolol), the measurements were repeated. Measurements were also made on an age- and sex-matched group of healthy controls (HC). In each case data were recorded for 30 min. In HC, the difference in absolute spectral amplitude of LDF oscillations between the two vasodilators manifests in the frequency interval 0.005–0.0095 Hz (p<0.01); this difference is initially absent in patients with CHF, but appears following the β1-blocker treatment (p<0.01). For HC, the difference between the two vasodilators also manifests in normalised spectral amplitude in 0.0095–0.021 Hz (p<0.05). This latter difference is absent in CHF patients and is unchanged by treatment with β1-blockers. It is concluded that there are two oscillatory skin blood flow components associated with endothelial function. Both are reduced in CHF. Activity in the lower frequency interval is restored by β1-blocker treatment, confirming the association between CHF and endothelial dysfunction but suggesting the involvement of two distinct mechanisms.

The effect of topical local anaesthetic agents upon forearm skin blood flow reactivity

The effect of topical local anaesthetic agents upon forearm skin blood flow reactivity

Neural control of cutaneous vasoconstriction during lower‐body negative pressure (LBNP) in the heat stressed individual

The decrease in cutaneous vascular conductance (CVC) during LBNP in the heat stressed human could be mediated by neural and non‐neural mechanisms. This project further investigated this question. Nerve activity to a forearm was blocked (via axial blockade) in seven healthy subjects. Two intradermal microdialysis probes were placed within the skin of the blocked area. Forearm skin blood flow was measured by laser‐Doppler flowmetry over these microdialysis probes, as well as from skin of the contralateral (non‐blocked) forearm. The absence of sweating and cutaneous vasodilation during heat stress confirmed an effective block. Upon this confirmation, adenosine was perfused through one microdialysis probe to increase skin blood flow similar to that of the non‐blocked site. After internal temperature was elevated ~1.0 °C, 30 mmHg LBNP was applied for 10 min, or until the onset of presyncopal symptoms. LBNP significantly decreased CVC at all three sites (unblocked site: −6.1±2.7; blocked site: −2.5±1.3%max; blocked site with adenosine: −5.4±2.2%max), although the magnitude of reduction in CVC was not different between unblocked and adenosine sites. When combined with prior data, these findings suggest that reductions in CVC to LBNP of heat stressed individuals could have both neural and non‐neural components.Study funded by part by NIH HL61388 &amp; HL84072

Age and thermoregulatory blood flow during treadmill exercise

The purpose of this study was to determine if age impacts the cutaneous vascular (thermoregulatory) response to exercise in women. Seven healthy women ages 20–24 were studied and compared to a group of seven healthy women ages 51–58. The exercise consisted of 20 min of brisk treadmill walking at a room temperature of 32 deg Celsius and a relative humidity of 45%. Skin blood flow (SBF) at the anterior forearm (dominant arm) and mid‐back was recorded immediately before and then throughout the exercise. A dual‐channel laser Doppler flowmeter was used to measure the SBFs, and the values were stored in computer and later analyzed by commercial software. Using ANOVA procedures mean SBFs for both skin locations were then compared before and at 2 min intervals during the exercise. The responses in the two age groups were then compared to determine if age had an effect on the vascular responses to exercise. Results showed vasodilation at each skin location in both groups with exercise. When the two groups were compared, it was found that the vascular responses were most pronounced in the younger group. The forearm SBF was 23% higher in the young group (P&lt;0.05), and it was 34% higher at the back (P&lt;0.05). The differential vascular responses to exercise between the two groups are likely explained by the effects of age on the structure and function of the cutaneous microcirculatory bed.

The association between serum urate levels and arterial stiffness/endothelial function in stroke survivors

There is increasing evidence that serum uric acid is an independent marker of cardiovascular risk. We have shown previously that high urate is associated with cardiac death in stroke survivors independently of conventional risk factors. We sought to determine in stroke survivors the association between high urate levels and arterial stiffness and endothelial function. One hundred and twenty stroke survivors were recruited. We assessed pulse wave velocity of the carotid artery using an echotracking ultrasound system. Endothelial function was assessed by measuring forearm skin blood flow responses, using laser Doppler imaging, to iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). Patients with high serum urate (0.42–0.71 mmol/l) had a greater pulse wave velocity ( P < 0.02) and a lower ACh response ( P = 0.001) than patients with lower urate (0.12–0.28 mmol/l). Pulse wave velocity significantly correlated with serum urate ( r = −0.358, P < 0.001), HDL cholesterol ( r = −0.22, P = 0.02), and male gender ( r = 0.26, P = 0.005). The ACh response significantly correlated with serum urate ( r = −0.30, P = 0.001), male gender ( r = −0.45, P < 0.001), HDL cholesterol ( r = 0.42, P < 0.001), and triglycerides ( r = −0.24, P = 0.01). Stepwise multiple regression showed that serum urate was significantly associated with pulse wave velocity ( β = 0.35, P < 0.001), independently of other risk variables. For the ACh response the significant determinants were male gender ( β = −0.38, P < 0.001) and HDL cholesterol ( β = 0.23, P = 0.018). We have shown for the first time that elevated serum urate is associated with increased arterial stiffness in stroke survivors, independently of other risk factors. A therapeutic intervention trial of lowering of serum urate is required to see whether this will impact positively on mortality and morbidity in patients with high-risk of strokes.

Is the magnitude of acute post-exercise hypotension mediated by exercise intensity or total work done?

The purpose of this study was to investigate the effects of exercise intensity on the magnitude of acute post-exercise hypotension while controlling for total work done over the exercise bout. Seven normotensive physically active males aged 28 +/- 6 years (mean +/- SD) completed four experimental trials, a no exercise control, 30 min of semi-recumbent cycling at 70% VO2peak (INT), cycling for 30 min at 40% VO2peak (SMOD) and cycling at 40% VO2peak for a time which corresponded to the same total work done as in the intense trial (LMOD). Blood pressure (BP), heart rate, stroke volume, cardiac output, total peripheral resistance, core body temperature and forearm skin and limb blood flow were measured prior to and for 20 min following the exercise bout. Post-exercise summary statistics were compared between trials with a one-factor general linear model. The change in systolic BP, averaged over the 20-min post-exercise period was significantly lower only following the INT (-5 +/- 3 mm Hg) and LMOD exercise (-1 +/- 7 mm Hg) compared to values in control (P < 0.04). The changes in systolic BP and MAP following INT and LMOD were not significantly different from each other (P > 0.05). Similar results were obtained when the minimum values of these variables recorded during the post-exercise period were compared. Mean changes in cardiac output (1.9 +/- 0.3 l min(-1)) and total peripheral resistance (-3 +/- 1 mm Hg l(-1 )min(-1)) after INT exercise were also different from those in CON (P < 0.0005). The acute post-exercise reduction in BP was clinically similar following high intensity short duration exercise and moderate intensity longer duration exercise that was matched for total work done.

Effect of hypercapnia on skin blood flow during normothermia and whole‐body heating

Normoxic hypercapnia increases sympathetic outflow to muscle, presumably causing vasoconstriction. Whether similar responses occur in the cutaneous vasculature is unknown. This study tested the hypothesis that normoxic hypercapnia decreases cutaneous vascular conductance (CVC) during normothermia (NT) and whole-body heating (WBH), with greater reductions in CVC during WBH. Four men and 3 women (mean±SD; age: 34±7 yr) rested supine while wearing a tube-lined suit perfused with 34 °C water (NT), followed by perfusion of 50 °C water to increase internal temperature ~1 °C (WBH). During each thermal condition, a normoxic 5% CO2 gas mixture was inspired for ~4 min while forearm skin blood flow (SkBF; laser Doppler flowmetry) and mean arterial blood pressure (MAP) were measured continuously for the subsequent calculation of CVC (SkBF/MAP). End-tidal CO2 increased similarly during hypercapnic exposure in both NT and WBH (+7.9±2.4 and +8.3±1.9 mmHg, respectively; P=0.66). No differences in CVC were observed between pre-hypercapnic baseline and hypercapnia in either NT (P=0.33) or WBH (P=0.87). These results indicate that CVC is not affected by hypercapnia under normothermic and heat stress conditions. Mild hypercapnia, therefore, is unlikely to impair human thermoregulation by means of reducing SkBF. Funded by NIH grants HL-61388 and HL-84072.

Skin tissue water and laser Doppler blood flow during a menstrual cycle

Previous work offers conflicting evidence concerning whether basal skin blood flow (SBF) varies with the menstrual cycle. Our goal was to determine the extent of cycle-dependent changes in forearm SBF parameters and if they are linked to local tissue water content and arm volume changes. Both arms of 10 premenopausal women were evaluated three times during their cycle (days 4, 12 and 22) and 10 postmenopausal women were evaluated once. Each evaluation included laser Doppler blood flow parameters (perfusion, volume and velocity), skin temperature, arm volume and local tissue water determined by a new tissue dielectric constant method. Estradiol and progesterone concentrations were determined at each visit by using saliva samples and analysis showed the expected pattern of variation over the cycle. Main results showed no significant cycle-dependent variations in any SBF parameter, temperature, tissue water or arm volume. Postmenopausal women had significantly less estradiol levels, but did not differ with respect to premenopausal women in any measured parameter except for a slightly less blood velocity (P<0.01). We hypothesize that that the absence of changes in tissue water and arm volume in our group may account for the constancy of the measured SBF parameters. However, in other populations, hormonally induced tissue changes may occur and contribute to the cycle-dependent changes in resting blood perfusion that have been reported. This possibility suggests that it may be useful to measure and report a skin tissue water index when serial changes in blood perfusion are being investigated.

Exercise Tolerance in a Hot and Humid Climate in Heat-Acclimatized Girls and Women

This study compared physiological responses associated with exercise tolerance in girls (G) and women (W) of similar fitness and heat acclimatization level during exercise in a hot and humid outdoor environment (33.4 degrees C and 55.1 % RH; WBGT = 29.9 +/- 0.2 degrees C). Nine pre-menarcheal G (age = 11.3 yr) and nine W (age = 26.8 yr), matched for aerobic capacity and heat acclimatization level, performed a cycling session at 60 % VO2max until fatigue. A sports drink was provided periodically to prevent dehydration. Tolerance time was not different between the groups (G = 56.9 +/- 6.3, W = 76.5 +/- 9.9 min, p > 0.05). During exercise, sweat rate (G = 9.1 +/- 1.1, W = 12.0 +/- 1.1 ml.m(-2).min(-1)), the increase in rectal temperature [T(re)] (G = 0.9 +/- 0.1, W = 1.1 +/- 0.1 degrees C), and heat storage (G = 10.6 +/- 5.3, W = 20.5 +/- 4.5 W.m(-2)) did not differ between the groups. At fatigue, T(re) (G = 38.2 +/- 0.1, W = 38.4 +/- 0.1 degrees C), heart rate (G = 167.3 +/- 7.3, W = 171 +/- 3.3 beats.min(-1)), stroke index (G = 48.3 +/- 1.5, W = 52.4 +/- 1.8 ml.m(-2)), and forearm skin blood flow (G = 9.5 +/- 1.3, W = 11.7 +/- 1.5 ml.100 ml(- 1).min(-1)) did not differ between the groups. Similar to women, the main reasons reported by girls to stop exercising in the heat were localized leg fatigue and gluteus muscle discomfort. We conclude that heat-acclimatized girls exhibit an adequate cardiovascular and thermoregulatory adjustment while exercising in a hot and humid outdoor environment when hypohydration is prevented.

Valsartan improves resting skin blood flow in type 2 diabetic patients and reduces poly(adenosine diphosphate-ribose) polymerase activation

To examine the effect of a 12-week daily treatment with 160 mg of valsartan, an angiotensin II receptor blocker, on the microcirculation and macrocirculation of type 2 diabetic patients (T2DM) and healthy subjects. This was a prospective, randomized, double-blind, placebo-controlled crossover study. Thirteen T2DM with no severe complications and 13 healthy subjects completed the trial. Treatment with valsartan in T2DM improved the resting forearm skin blood flow and increased the resting brachial artery diameter but had no effects on arterial blood pressure, large vessel vascular reactivity, or carotid intima-media thickness. Resting skin blood flow increased by 60% (2%-90%; median and 25th-75th percentiles) during valsartan treatment and by only 2% (-22% to 27%) during placebo treatment (P < .05). No changes were observed in the nondiabetic subjects. Immunostaining studies of forearm skin biopsy samples from T2DM and healthy subjects showed that valsartan reduced poly(adenosine diphosphate-ribose) polymerase (PARP) activity in 50% (6/12) of the subjects. PARP activity remained unchanged in placebo-treated subjects (P < .02). In addition, valsartan treatment increased CD31 staining in 33% (4/12) of the subjects, whereas no change was noted in sequential skin biopsy samples of placebo-treated subjects (P = .057). Valsartan had no effect on the biochemical markers of endothelial cell activation and other cytokines, including CAMs, interleukin 6, tumor necrosis factor alpha, C-reactive protein, adiponectin, and plasma activator inhibitor 1. Valsartan increases the resting skin blood flow in T2DM, likely through reduction of PARP activity.